Fleming, William . - . ,-i, itSt
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William Edward Fleming . Male
Date of Death Age If Veteran of U.S. Armed Forces,
02/04/2015 83 years War or Dates 1950-54
#- P ce of Death Hospital, Institution or
taZ
City, T Xr)QXJX Glens Falls Street Address Park St Glens Falls, N Y 12801
Et Fanner of Death 0 Natural Cause 0 Accident ❑Homicide 0 Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
a John Rugge M.d.
• Address
Warrensburg Health Center Warrensburg, Ny
D-- h Certificate Filed District Number Register Number
QVT XrX4pi!( C Glens Falls 5601 68
■Burial Date Cemetery or Crematory
02/09/2015 • Pine View Cemetery
❑Entombment Address •
OCremation Queensbury, NY 12804 .
Date . Place Removed
Z Removal and/or Held
2❑and/or
� Address
t)
Hold
0 Date Point of
d 0 Transportation Shipment
Gt by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Barton- Mc Dermott Funeral Home, Inc. 00141
Address
9 Pine Street Chestertown, N Y 12817
giiii Name of Funeral Firm Making Disposition or to Whom -`
1- Remains are Shipped, If Other than Above
• Address
iii
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/06/2015 Registrar of Vital Statistics ,,,� ,p
�' ''4 0 " ` LA)(sigt. re)
giii District Number 5601 Place Glens Falls ,,(✓y / l -1j
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
ILI Date of Disposition 2/gb/I'S Place of Disposition gt11.. Crkv-40(+-.
2 (address)
Ui
to
cc (section) // (lot number) (grave number)
0
Name of Sexton or Pe son in Charge of Premises t, L ice"
r (please print)
Signature Title litetat1N,
(over)
DOH-1555 (02/2004)